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The Therapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Registries)

https://doi.org/10.20996/1819-6446-2019-15-4-538-545

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Abstract

Aim. To evaluate an incidence of oral anticoagulants (OAC) administration during longterm follow-up period in patients with atrial fibrillation (AF) enrolled in outpatient and hospital RECVASA registries.

Material and methods. 3169 patients with AF were enrolled in outpatient registries RECVASA (Ryazan), RECVASA AF-Yaroslavl and hospital registries RECVASA AF (Moscow, Kursk, Tula), age 70.9±10.7 years, 43.1% men. The incidence of OAC administration was evaluated in hospital and outpatient settings, including longterm follow-up period (2-6 years).

Results. OAC were administrated only in 42.2% of cases (1335 from 3169 patients; age 69.1±10.4 years, 43% men), including warfarin (817 patients; 26%) and non-vitamin K antagonist oral anticoagulants (NOAC) – 518 (16%). Patients with permanent and persistant types of AF had lower incidence of OAC administration (43% and 40%) than in cases of paroxysmal type (47.6%, p<0.05), despite of the higher СНА2DS2-VASc risk score (4.69±1.66 and 4.23±1.57 vs 3.81±1.69; р<0.05). Patients with and without history of stroke received OAC in 42.5% and 40% of cases that means no significant difference (p>0.05) contrary to the pronounced difference of thromboembolic risk in these groups (6.14±1.34 and 3.77±1.39; р<0.001). The incidence of OAC administration in hospitals (54.1%) was 2.3 times higher than before hospitalization (23.8%) and was 4.1 times higher than in outpatient registries (13.5%). During follow-up period after hospital treatment (2.3±0.9 years) this parameter decreased from 54.1% to 41.2%, but was still 1.8 times higher than before admission to the hospital. After 4 years follow-up in RECVASA (Ryazan) registry we revealed 4.4 times higher incidence of OAC administration compared with enrollment data (4.2% and 18.3%, р<0.0001). This data was confirmed by the information from outpatient medical cards of accidentally generated group (75 from 297 patients survived during follow-up period): 5.3% at baseline and 22.7% six years later.

Conclusions. RECVASA registries in 5 regions of Russia revealed low incidence of OAC administration. The risk of thromboembolic events was higher in patients with AF and no OAC administration compared with patients who received OAC. Patients with paroxysmal type of AF received OAC more often than those with permanent type. There were no significant differences of incidence of OAC therapy in patients with and without history of stroke. Both questioning of patients with AF and analysis of medical cards in outpatient clinics revealed higher incidence of OAC administration after 4-6 years of follow-up compared with the stage of enrollment in registries.

About the Authors

M. M. Loukianov
National Medical Research Center for Preventive Medicine
Russian Federation

Mikhail M. Loukianov – MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990 Russia



S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation

Sergey Yu. Martsevich – MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy

Petroverigsky per. 10, Moscow, 101990 Russia



O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation

Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director

Petroverigsky per. 10, Moscow, 101990 Russia



S. S. Yakushin
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Sergey S. Yakushin – MD, PhD, Professor, Head of Chair of Hospital Therapy

Visokovoltnaya ul. 9, Ryazan, 390026 Russia



A. N. Vorobyev
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Alexander N. Vorobyev – MD, PhD, Associate Professor, Chair of Hospital Therapy

Visokovoltnaya ul. 9, Ryazan, 390026 Russia



K. G. Pereverzeva
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Kristina G. Pereverzeva – MD, PhD, Assistant, Chair of Hospital Therapy

Visokovoltnaya ul. 9, Ryazan, 390026 Russia



A. V. Zagrebelnyy
National Medical Research Center for Preventive Medicine
Russian Federation

Alexander V. Zagrebelnyy – MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy

Petroverigsky per. 10, Moscow, 101990 Russia



V. Val. Yakusevich
Yaroslavl State Medical University.
Russian Federation

Vladimir Val. Yakusevich – MD, PhD, Professor, Chair of Clinical Pharmacology

Revolutsionnaya ul. 5, Yaroslavl, 150000 Russia



V. Vl. Yakusevich
Yaroslavl State Medical University.
Russian Federation

Vladimir Vl. Yakusevich – MD, Researcher, Chair of Clinical Pharmacology

Revolutsionnaya ul. 5, Yaroslavl, 150000 Russia



E. M. Pozdnyakova
Yaroslavl State Medical University.
Russian Federation

Ekaterina M. Pozdnyakova – MD, Researcher, Department of Clinical Pharmacology

Revolutsionnaya ul. 5, Yaroslavl, 150000 Russia



T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation

Tatiana A. Gomova – MD, PhD, Deputy Chief Physician for General Issues

Yablochkova ul. 1а, Tula, 300053 Russia



E. E. Fedotova
Tula Regional Clinical Hospital
Russian Federation

Elena E. Fedotova – MD, Cardiologist, Clinical and Diagnostic Center

Yablochkova ul. 1а, Tula, 300053 Russia



M. N Valiakhmetov
City hospital №3 of Tula
Russian Federation

Marat N. Valiakhmetov – MD, Acting Chief Physician for Therapeutic Care

Pushkina ul. 17, Tula, 300910 Russia



V. P. Mikhin
Kursk State Medical University
Russian Federation

Vadim P. Mikhin – MD, PhD, Professor, Head of Chair of Internal Medicine №2

Karla Marxa ul. 3, Kursk, 305041 Russia



Yu. V. Maslennikova
Kursk State Medical University
Russian Federation

Yulia V. Maslennikova – MD, PhD, Chair of Internal Medicine №2

Karla Marxa ul. 3, Kursk, 305041 Russia



E. Y. Andreenko
National Medical Research Center for Preventive Medicine
Russian Federation

Elena Yu. Andreenko – MD, PhD, Senior Researcher, Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990 Russia



V. G. Klyashtorny
National Medical Research Center for Preventive Medicine
Russian Federation

Vladislav G. Klyashtorny – PhD (in Biology), Researcher, Laboratory of Biostatistics

Petroverigsky per. 10, Moscow, 101990 Russia



E. V. Kudryashov
National Medical Research Center for Preventive Medicine
Russian Federation

Egor V. Kudryashov – Programmer, Laboratory of Biostatistics

Petroverigsky per. 10, Moscow, 101990 Russia



E. Yu. Okshina
National Medical Research Center for Preventive Medicine
Russian Federation

Elena Yu. Okshina – MD, PhD, Senior Researcher, Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990 Russia



M. A. Panagopulu
National Medical Research Center for Preventive Medicine
Russian Federation

Marina A. Panagopulu – MD, cardiologist

Petroverigsky per. 10, Moscow, 101990 Russia



S. A. Boytsov
National Medical Research Center of Cardiology
Russian Federation

Sergey A. Boytsov – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 Russia



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For citation:


Loukianov M.M., Martsevich S.Y., Drapkina O.M., Yakushin S.S., Vorobyev A.N., Pereverzeva K.G., Zagrebelnyy A.V., Yakusevich V.V., Yakusevich V.V., Pozdnyakova E.M., Gomova T.A., Fedotova E.E., Valiakhmetov M.N., Mikhin V.P., Maslennikova Y.V., Andreenko E.Y., Klyashtorny V.G., Kudryashov E.V., Okshina E.Y., Panagopulu M.A., Boytsov S.A. The Therapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Registries). Rational Pharmacotherapy in Cardiology. 2019;15(4):538-545. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-4-538-545

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